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r t,-V4I2Tr <br />(. At <br />eERMIT APPLICATION c&)s c.-r- <br />CITY OF EVERETT PERMIT SERVICES Cb23336 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE DRESS 1 0 <br />PARCEL TAX I.D. # <br />PERMIT # <br />c442c i /Akk- ,r <br />LEGA LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS IP PHONE <br />TENANT NAME <br />8� <br />CONTACT FOR PERM <br />a PHONE <br />,tom 5 % b ?12. (*40 <br />CONTR CCTOR ADDRESS ZIP CONTR. LICENSE # <br />-tAF Sfii��7Z�flM INS <br />PHONEW �O���-'� lQ; <br />PROPOSED1 USE OF BUILDING <br />PERMIT <br />li�So <br />TYPE <br />ilding Mechanical <br />mbination R Plumbing <br />molition D Sign <br />ddrati <br />rAlt, <br />WORK ration <br />TYPEew <br />HEATSOURCE <br />Electric <br />Gas <br />2 �'mQAN r <br />finkl <br />epair/Maint. <br />Other <br />CONTRACT PRICE OF WORK 2' W LIJ CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION (t 0 � I IY� I(`(���Yof7, <br />JT�J <br />�L( 1� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />_ <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />_ <br />_ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />HEAT PUMP <br />UNIT HEATERS <br />_ <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />_ <br />_ <br />CLOTHES DRYER <br />_ <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />WATER HEATER <br />_ <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />_ <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />_ <br />URINAL <br />_ <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />_ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />_ <br />_ <br />GAS RANGE <br />_ <br />_ <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />EXHAUST FAN <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />OTHER <br />OTHER <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />STATE OR LOCAL LAW <br />OWNER OF THIS RO ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS W 1 27 RCW AND 296.200 WAC. <br />SI natur o w er Con ractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />